Vol 11, No 2 (2014)

The review of literature shows the modern analysis of medical approaches for cardiovascular disease primary prevention. We have been discussing the necessity of antiaggregant and statin therapy in such cases and also studding new results of involving antihypertensivetherapy (calcium antagonist - amlodipine) to prevent stroke and heart attack.

Relevance. Impact of the drugs on adaptation to the heat wave of abnormal temperature has been one of the most important practical medicine questions in recent years. One of the points at issue is safety calcium channel antagonists and ACE inhibitors treatment during abnormal heat. The aim of the study is to investigate the efficacy and safety of perindopril arginine (drug Prestance - Servier Industries, Ltd.) and amlodipine fixed combination in arterial hypertension (AH) patients during the summer heat and the summer heat influence on the adaptation mechanisms to abnormally high temperatures.Materials and methods. The study enrolled 165 patients with stages 1 and 2 AH: 69 patients with average risk and 91 patients with high andvery-highrisk of cardiovascular complications. There were 69 men and 96 women in the study, living in Moscow city, in the Moscow and in the Ivanovo Regions. All patients were measuring office BP, biochemical blood assay and hematocrit and were running questionnaire survey: visual analogue scale (VAS), Morisky-Green test and questionnaire for the patients who were exposed to heat. Pulse ware velocity was measured in 30 patients. The first visit was done in the first half of June 2013, the second visit - during the heat (July 2013), the third one in September 2013. Results. In the course of the study systolic (SBP) and diastolic BP (DBP) were reduced (р<0,00001) and the SBP and DBP target level reached 73,9% (41,9% - durig the second visit). We observed the increase of VAS and Morisky-Green test scores from 2,24±1,43 (Ме 2,0) to 3,26±0,91 (the 2ed visit) and to 3,49±0,91 (Ме 4,0) (3ed visit), hyperkalemia (р=0,0056), hyponatremia (р=0,00042), hypocreatinemia (р=0,018), hypocholesterolemia (р<0,00001), hypotrigliceridemia (р=0,027), hypoglucosemia (р=0,0035). We noted pulse ware velocity and hematocrit reduction (the 3ed visit). Conclusion. Therapy of Prestance was effective, safe and well tolerated by AH patients during the summer heat without any sings of hypotension and electrolyte imbalance which were attributed to bodyheat. Improvement of adaptive response in the human body was associated with effective arterial elastance and reduction in blood viscosity.

Aim: to evaluate the main parameters of the microcirculatory blood flow and to determine its reserve capacity in patients with arterial hypertension (AH) and different degrees of cardiovascular risk (CVR).Subjects and methods. We examined 64 subjects aged 47-58 years, of which 27 were healthy volunteers and 37 patients with 1st and 2nd degree arterial hypertension, with medium, high and very high CVR (the antihypertensive therapy was cancelled for 2 weeks before the study). In all subjects laser Doppler flowmetry (LDF) with studing initial perfusion parameters, 2 constrictor and 3 dilatator tests waky perfomed. To assess the status of the tone-shaping «active» and «passive» parts of microcirculatory modulation, analysis of the amplitude and frequency spectrum of LDF- grams was carried out.Results. A significant increase in the rate of «base perfusion» in all hypertensive groups compared with the control group was found. The amplitude of respiratory oscillations was one-third higher in high and very high CVR groups in comparison with the control, the amplitude of the myogenic and neurogenic oscillations were maximal and reached significant values in very high CVR group. A reduction in constrictor response in hypertensive patients with middle and high CVR and its increase in the very high CVR group was shown during constrictor functional tests. The power of perfusion increase was reduced in response to all kinds of dilatator stimulus in hypertensive patients group.Conclusion. The findings indicate a progressive increase in the level of «base perfusion», worsening of venous congestion symptoms in hypertensive patients with the progression in CVR severity. High and very high CVR patients showed a reduction in myogenic tone of microvessels when compared with those with normotension. Dilatator functional tests showed a tendency to lower capillary blood flow reserve in hypertensive patients compared with the control group.

Familial hypercholesterolemia (FH) is an inherited disease that results in high levels of total cholesterol, causing the risk of early ischemic heart disease (IHD). Rosuvastatin is the high-potency hypolipidemic agent of HMG-CoA reductase inhibitors which is approved for clinical use.The goal of our research is to study efficacy, safety Mertenil (rosuvastatin) acceptability of maximal course dose of 40 mg in patients with phenotypic FH. Materials and methods. The 16-week open study was prospective. The study included 40 men and women at the age of 18 years and older with phenotypic FH. 18 patients had the Arg3500Gln mutation in APOB100 gene. Men accounted for 40% of total number of patients. The average age of patients was 55,9 years and average LDL cholesterol (LDL-c) level was 7,2 (1,2) mmol/l. Patients did not accept statins before the inclusion in this study (for a period no less than 3 months).Results. Rosuvastatin40 mg monotherapy 16 weeks study contributed to decrease LDL-c by 50% (p<0,001) and ApoB-100 by 45,1% (p<0,001), TG by 20,1% (p<0,01). Aspartate aminotransferase, alanintransferase and creatinekinase activity were not statistically significant from the base values and were not exceed 1,5 superior normal limit after 16-weeks study. Through 16 weeks of therapy the identified reduction of hsCRP and uric acid were observed (p<0,05). Side-effects were not observed throughout the period of treatment.Conclusion. Therapy of Mertenil (rosuvastatin) 40 mgis available and effective in treatment of heterozygous FH.

There is a problem of medicamental correction of arterial hypertension (AH) in patients with chronic obstructive lung disease (COLD), because number of drugs for the treatment of AH is limited in patients with bronchoobstractive diseases.The study shows that prolonged-release indapamide complex therapy is efficiency and safety (Arifon® retard) in patients with COLD associated with AH. The results demonstrate Arifon retard have positive effect on the AH: normalization of daily blood pressure (BP) profile and improvement of24-hour ambulatory blood pressure monitoring levels.At the same time it is shown that administration of Arifon retard does not affect the pulmonary ventilation rates (the results of the spirometry) and does not increase the lung hyperinflation (according to the results of Body plethysmography), and is not associated with hypokalaemia. The results of the study demonstrate that Arifon® retard can be used for safe correction of BP in patients with COLD associated with AH.

The article deals with the characteristics of angiotensin-II receptor antagonist pharmacokinetics. We have shown the differential characteristic of pharmacokinetics and pharmacodynamics of candesartan. The results demonstrate the clinical efficacy of candesartan in treatment of arterial hypertension (AH) and inreducing the risk of complications.